Application of the predicted biomechanics approach in assessing work-related musculoskeletal discomfort among female brickfield workers in West Bengal, India.

BACKGROUND: Manual brick manufacturing units in West Bengal, India are mostly unorganized sectors employing many migrant female workers in manual material handling tasks as brick moulders and brick carriers. OBJECTIVE: The study estimated the biomechanical postural stress developed due to manual load handling, carriage and brick transportation. METHODS: Body Part Discomfort Scale was used to assess the subjective pain felt by 18 adult female brick moulders and 12 brick carriers during work. Video recordings were taken during the actual field work and the images were analyzed for two-dimensional prediction kinetics and kinematics. RESULTS: Results show that the horizontal distance of the load from the body was 59.95±3.74 cm during the initial lifting of bricks by the brick carriers and so their biomechanical trunk angle inclination was significantly detrimental. The bending moment at the lumbosacral disc was much higher during the squatting posture while initial brick lifting. Moreover, the trunk and the neck pain of the brick carriers were caused by carrying 18% of body weight load. CONCLUSIONS: The brick carriers were the more vulnerable group in terms of work-related musculoskeletal disorders. Therefore, ergonomic interventions such as relay brick carrying and pole supported balanced brick carrying, may be implemented to reduce the prevalence of pain. This study is the first of its kind that validates the extent or the prevalence of work-related musculoskeletal disorders among the female brickfield workers through approaches of predicted biomechanics.

Animal Welfare Attitudes: Effects of Gender and Diet in University Samples from 22 Countries.

Animal Welfare Attitudes (AWA) are defined as human attitudes towards the welfare of animals in different dimensions and settings. Demographic factors, such as age and gender are associated with AWA. The aim of this study was to assess gender differences among university students in a large convenience sample from twenty-two nations in AWA. A total of 7914 people participated in the study (5155 women, 2711 men, 48 diverse). Participants completed a questionnaire that collected demographic data, typical diet and responses to the Composite Respect for Animals Scale Short version (CRAS-S). In addition, we used a measure of gender empowerment from the Human Development Report. The largest variance in AWA was explained by diet, followed by country and gender. In terms of diet, 6385 participants reported to be omnivores, 296 as pescatarian, 637 ate a vegetarian diet and 434 were vegans (n = 162 without answer). Diet was related with CRAS-S scores; people with a vegan diet scored higher in AWA than omnivores. Women scored significantly higher on AWA than men. Furthermore, gender differences in AWA increased as gender inequality decreased.

COVID-19 pandemic lockdown-induced altered sleep/wake circadian rhythm, health complaints and stress among traffic police personnel in India.

COVID-19 is a highly contagious disease caused by Severe Acute Respiratory Syndrome coronavirus-2, capable of high human transmission. To protect against the COVID-19 pandemic, the World Health Organization proposed intervening guidance that included movement restrictions, isolation, restriction of national and international travel or movement, and full or partial closure of organizations and institutions. Police personnel play a vital role in safeguarding the spread of COVID-19; thus, potentially causing severe stress due to increased consignment and direct exposure to infection during duty. The study aimed to determine the effect of the added stress of the COVID-19 pandemic and population lockdown on the sleep/wake 24 h rhythm of traffic police. A concise online questionnaire survey was conducted among the traffic police personnel of India. Collected data were analyzed statistically. Disorientation of working schedule, fear of being vulnerable to disease, pressure of maintaining law, and orders during lockdown increased stress level. The survey identified discontinuation of sleep, shift of mid-sleep time, increase in depression, plus stress and anxiety among traffic police personnel that affected their chronobiological milieu. Proper awareness of adequate health and safety measures, use of personnel protection equipment, regular conversation with family members, and meditation can help reduce stress during this pandemic situation.

COVID-19 pandemic and lockdown: cause of sleep disruption, depression, somatic pain, and increased screen exposure of office workers and students of India.

COVID-19 has brought the world into uncharted waters. Many countries are under lockdown, the economy has ground to a halt, and almost everyone is afraid of dire consequences. The unprecedented changes that came on so quickly due to the pandemic and stay-at-home confinement to accomplish social distancing and mitigate risk for infection pose many challenges. These include compromised health, well-being, and sleep as a consequence of disruption of the daily life routine, anxiety, worry, isolation, greater family and work stress, and excessive screen time. Our study of 203 corporate sector professionals performing '9-5' work from home during this phase of the pandemic and of 325 undergraduate and postgraduate university students substantiates, relative to the before lockdown condition, more extensive feelings of sleepiness, with significantly (p < .05) increased daytime nap duration, and depressive symptomatology (p < .001) that is a matter of concern. Moreover, the chronic stress of living through a pandemic led to a host of physical symptoms, like headaches, insomnia, digestive problems, hormonal imbalances, and fatigue.

Morningness orientation is an important determinant to circadian misalignment and tolerance: an Asian perspective.

Diurnal preferences refers to one's preference of performing timely activities where one may prefer for late timings and the other for earlier, which account for their chronotype that is controlled partly by genetic factors and are also influenced by environmental factors. Individual's circadian preference can be drawn using questionnaire tools as well as can be externally validated by studying various physiological parameters that has a rhythmicity. Determination of chronotype is well studied worldwide but mostly in European and American countries. Asia being the largest continent, comprising so many countries still did not have widespread studies over chronotype assessment and its implications. This review aims at jotting down the available literature regarding the chronotype evaluation and the various contributing factors in Asian perspectives such that there can be huge cross-cultural studies emphasizing environmental, geographical differences, lifestyle habits, work schedule, and other contributing factors regarding the understanding of circadian preference of humans, which is really hard to define. The dearth in studies regarding diurnal preferences and physiological altercations, which is in turn influenced by the work schedule and the resultant sleep-wake pattern disorientation, needs further investigation worldwide and this available literature may put some light in the path of future research scope.

Exposure to heavy metals alters the surface topology of alveolar macrophages and induces respiratory dysfunction among Indian metal arc-welders.

BACKGROUND: Despite the available clinico-epidemiological evidence of heavy metal-associated respiratory health hazards among metal arc-welders, experimental confirmation of such an association is lacking. METHODS: In this study, we recruited 15 metal arc-welders and 10 referent workers without direct exposure. We assessed respiratory health through a questionnaire and spirometry; estimated manganese, nickel and cadmium levels in blood, urine and induced sputum; performed differential counts of sputum leucocytes and measured plasma malondialdehyde (MDA). We used atomic force and scanning electron microscopy to assess the physical property of the alveolar macrophages (AMs) obtained from induced sputum and analysed cell surface deposition of heavy metals using energy dispersion X-ray analysis (EDX). Sputum cellular DNA damage was assessed by DNA-laddering assay. RESULTS: There was a higher body burden of manganese and nickel in the metal arc-welders than the referents. Among major spirometric indices, only the forced mid-expiratory flow rates (FEF25-75) were reduced in the welders compared with the referents (63.4 ± 14.7 vs. 89.2 ± 26.7, p < 0.01); this reduction was associated with both heavy metal levels (ß: -41.8, 95% CI: -78.5% to -5.1%) and plasma MDA (-0.37; -0.68 to -0.06). In metal arc-welders, significant physical and morphological changes were observed in AMs through microscopic evaluation while EDX analyses demonstrated higher deposition of heavy metals on the AM cell surface than the referents. We also observed a higher degree of DNA damage in the sputum cells of the exposed workers than the referents. CONCLUSION: Heavy metal exposure-induced adverse respiratory effects among metal arc-welders are mediated through haematological and cytological interactions.

A physiological exploration on operational stance and occupational musculoskeletal problem manifestations amongst construction labourers of West Bengal, India.

BACKGROUND: A huge number of labourers work in the construction industry in India both in organized and unorganized sectors. The construction labourers most often work for an extended period of time and they are compelled to uphold altered static and dynamic operational stance in awkward positions during the complete period of work which raises the demand on the musculoskeletal system and may lead to work related musculoskeletal disorders (WRMSDs). OBJECTIVE: This study is intended to explore the operational stance and occupation related musculoskeletal manifestations amongst the construction labourers. One hundred sixty four male labourers from different construction sites in West Bengal were randomly taken for this study. METHODS: A modified Nordic questionnaire on MSD and the 12 item General Health Questionnaire (GHQ12) were administered on the construction labourers. Rapid Entire Body Assessment (REBA) and Ovako Work Analysis System (OWAS) methods were applied to analyze the operational stance. Finally, discomfort levels of the specific operational stance were calculated by the use of risk level and BPD scale. RESULTS: The study revealed that most of the construction labourers habitually worked in awkward operational stance and were affected by altering musculoskeletal manifestations like pain in low back, neck, and wrist. We also found that there is a significant (p< 0.05) association between the intensity of pain feeling, age, year of working experience and risk level of the individual working postures of the labourers. CONCLUSION: Appropriate work-rest schedule, amendments of some working techniques and use of some ergonomically designed equipment may lessen the WRMSDs and improve the health eminence of construction labourers in unorganized sectors.

Impact of rest breaks on musculoskeletal discomfort of Chikan embroiderers of West Bengal, India: a follow up field study.

OBJECTIVES: This study aimed to determine risk factors that predict musculoskeletal discomfort in Chikan embroiderers of West Bengal, India, and to compare the effect of two rest break schedules to reduce these symptoms. METHODS: The Nordic musculoskeletal questionnaire was performed on 400 Chikan embroiderers at baseline containing questions on job autonomy, working behavior, and work stress factors. Relative risk was calculated to identify prognostic factors for musculoskeletal discomfort in different body regions. Two groups of workers received two rest break schedules for 4 months and compared in a between-subject design. Outcome variables were scores of Body Part Discomfort (BPD) scale. RESULTS: Chikan embroiderers are afflicted with musculoskeletal discomfort mainly in the lower back, neck/shoulder and wrist/forearm region, which is attributed to their prolonged working timeinvolving hands and wrists, being in a static seating posture. Rigidity in working methods, prolonged working time, inadequate rest break during the working day, dissatisfaction regarding earning, monotonous work, static sitting posture, and repetitive movement of wrist and forearm were the significant predictors of these symptom developments. Rest break schedule 1 with more frequent and shorter breaks had more significant improvement on the severity of these musculoskeletal discomforts. CONCLUSIONS: Chikan embroiderers perform a highly dreary occupation and various ergonomics conditions work as predictors for developing musculoskeletal discomforts among them. Design of proper rest break schedule involving shorter and frequent breaks was competent for reducing these discomforts to a certain extent.

Impact of occupational cadmium exposure on spirometry, sputum leukocyte count, and lung cell DNA damage among Indian goldsmiths.

BACKGROUND: Cadmium is frequently used in manual jewelry industries. Although its toxicity on lung function is well-known, the mechanism is not well-understood. METHODS: Among 26 goldsmiths exposed to cadmium (mean age 35.9 ± 5.0 years) and 17 referent workers without direct exposure (36.6 ± 6.6 years), we measured blood and urinary cadmium concentration and performed spirometry and quantified leukocytes and comet formation in the cells from spontaneously expectorated sputum samples. RESULTS: The goldsmiths had higher cadmium concentration in urine (mean 6.14 ± 1.63 vs. 0.47 ± 0.17 µg/dl) and blood (0.90 ± 0.23 vs. 0.02 ± 0.007 µg/dl) than the referents, which were inversely associated with FEV1 /FVC. Cadmium exposure also resulted in higher neutrophils (%) and lower macrophage (%) prevalence in the sputum and also caused substantial DNA damage in the lung cells among the goldsmiths than the referents (69 vs. 14%). CONCLUSION: Altered lung function among cadmium-exposed goldsmiths was associated with enhanced inflammatory response and increased cellular DNA damage in the lungs.

Trawler fuel exhaust and respiratory impairments: a cross-sectional pilot study among Indian fishermen working in informal sectors.

BACKGROUND: An estimated half a billion people are engaged in fishing related occupations in India. Exposure to adulterated fuel exhaust is common among deep-sea fishermen, yet little is known about the potential impacts on the exposure to health. OBJECTIVE: The aim of this study was to investigate whether fuel emission exposure was associated with increased respiratory impairments among fishermen who were occupationally exposed to fuel exhaust compared to fisherman occupationally unexposed to fuel exhaust. METHODS: This cross-sectional study compared the prevalence of respiratory symptoms and lung function variables between 152 marine-water and 107 fresh water fishermen considering the use of fuel-driven trawlers. Data were obtained from questionnaires and computerized spirometer. RESULTS: Fishermen exposed to trawler fuel exhaust reported more than double the number of respiratory symptoms compared to the unexposed fisherman (86·2 vs. 40·2%). They also had a significantly higher chance experiencing chronic cough (adjusted OR = 3·51, 95% confidence interval (CI) = 2·09-6·35), chronic phlegm (8·61, 4·76-15·97), and wheezing (4·29, 2·55-7·61) symptoms. Finally, there was a significant reduction of the ratio of mid portion of forced expiratory flow rate and forced vital capacity (FEF25-75/FVC) in the exposed fishermen compared to the unexposed (0·84 vs. 0·73 second(-1), P = 0·015). CONCLUSION: Fuel exhaust may negatively impact on the respiratory health of Indian fishermen. More attention and surveillance of occupational health for fishermen in India is needed.

Fungal contamination of the respiratory tract and associated respiratory impairment among sawmill workers in India.

Wood processing workers are exposed to wood-associated microbiological contaminants, including fungi. Our aim was to study the potential association between sputum fungus and adverse respiratory effects in such workers. In a group of sawmill workers, we administered a respiratory questionnaire, performed lung function testing and quantified the proportions of leukocytes in spontaneously expectorated sputum samples. We identified fungal species by DNA sequencing. Of 54 sawmill workers, 19 yielded fungal positive sputum samples (mean age 42.5±10.4 years) and 35 were negative for fungus (mean age 36.9±5.2 years). The fungus was identified as Candida sp. in all samples. Those with fungal-positive sputum, compared to others, reported more cough (26% versus 63%) and haemoptysis (6% versus 37%) (both p<0.05), manifested reduced forced midexpiratory flow rates (FEF25-75%) (82.3±4.5 versus 69.2±9.9% predicted, p<0.001), and had higher sputum eosinophil counts (median 9.25 versus 3.25%, p<0.01). Reduction of FEF25-75% was associated both with fungus detection in sputum (-12.7%, 95% CI-8.5- -16.9%) and sputum eosinophils (-2.1% per 1% increase in eosinophils, 95% CI -1.5- -2.8%) (both p<0.001). In sawmill workers, Candida sp. detectable in sputum was associated with respiratory symptoms, sputum eosinophilia and reduced FEF25-75%.

Cross-cultural comparison of seven morningness and sleep-wake measures from Germany, India and Slovakia.

Morningness-eveningness or circadian typology can be viewed as an interesting aspect of individual differences. Morningness-eveningness is a preference for a given time of day for physical or mental performance, but also reflects aspects of affect. Here, we used seven different measures to assess differences in morningness-eveningness between Germany, Slovakia and India. The hypothesis was that Indians should be earliest chronotypes, followed by Slovakia and then Germany, because of higher temperatures in India, and the fact that Slovakia is located farther east compared to Germany. We applied the Composite Scale of Morningness (CSM), the Circadian Energy Scale (CIRENS), the CAEN Chronotype Questionnaire (CCQ), and habitual sleep-wake variables to calculate sleep duration, midpoint of sleep and social jetlag. Sample sizes were N = 300 (Germany), N = 482 (Slovakia) and N = 409 (India). Country had the strongest influence on morningness-eveningness. Germans were latest chronotypes and differed in all seven measures from Indians but differed from Slovakians only in the energy level at the evening and midpoint of sleep. Slovakians and Indians differed in all measures but the energy level (CIRENS). Women scored higher on the CSM, lower on CIRENS, lower on the morningness-eveningness (ME) scale, but higher on distinctness (DI) scale. Women slept longer and had an earlier midpoint of sleep.

Prevalence of low back pain among handloom weavers in West Bengal, India.

BACKGROUND: Handloom is one of the oldest industries in India, particularly in West Bengal, where a considerable number of rural people are engaged in weaving. OBJECTIVES: The purpose of this study was to evaluate the prevalence of low back pain among the handloom weavers in India. METHODS: A modified Nordic Musculoskeletal Disorder Questionnaire and Oswestry Low Back Pain Disability Questionnaire along with a body part discomfort scale were administered to handloom weavers (n = 175). Working posture of the participants was assessed using the Ovako Working Posture Analysis System (OWAS). RESULTS: Sixty eight per cent of the participants reported suffering from low back pain, making it the most prevalent disorder in our sample. Analysis of the Oswestry Low Back Pain Disability Questionnaire data revealed that among those with low back pain (n = 119), 2% had severe disabilities, 46% had moderate disabilities, and 52% had minimal disabilities. Statistical analyses revealed a positive significant association between the intensity of pain in the lower back and an increased number of years of work experience (P<0·05). CONCLUSIONS: The study underlines the need for further research regarding the postural strain of weavers and also suggests the implementation of ergonomic design into weaver workstations to minimize the adverse effect of their current working postures. Improving upon the weaver's work-posture could improve their quality of life.

Occupational cadmium exposure-associated oxidative stress and erythrocyte fragility among jewelry workers in India.

BACKGROUND: Cadmium-induced pulmonary and renal target organ effects are well-established although its association with oxidative stress and associated hematological effects for human toxicity remain understudied. METHODS: In a population of cadmium-exposed male jewelry manufacturing workers (n = 32) and referents without direct exposure (n = 21), all with urinary cadmium quantification, we measured plasma antioxidant enzymes (catalase, superoxide dismutase), lipid peroxidation (malondialdehyde), erythrocyte fragility, and surface irregularity of the erythrocyte membrane. RESULTS: Compared to referents, exposed workers manifested significantly lower plasma antioxidant enzymes, and increased malondialdehyde and erythrocyte fragility (for all, P < 0.01). Consistent with the exposure subcategories, activities of superoxide dismutase and catalase were reduced and lipid peroxidation and erythrocyte fragility were enhanced (P < 0.01 for all) in terms of Cd-effect indicating a strong impact on hematological system and oxidative stress. CONCLUSION: Cd exposure contributes to oxidative stress and related erythrocyte effects thus making the hematological system another end-organ target for chronic Cd toxicity.

Effects of occupational heat exposure on female brick workers in West Bengal, India.

BACKGROUND: Manual brick-manufacturing units in India engage a large number of female workers on a daily-wage basis for a period of 8 months per year. There are two groups of female workers in the brickfields: the brick molders and the brick carriers. These brickfields are mostly unorganized, and the workers are exposed to extreme conditions such as very high seasonal heat. The present trend of increasing temperatures, as a result of global warming and climate change, will put an additional burden on them. OBJECTIVE: This study aims to evaluate the effect of workplace heat exposure on the well-being, physiological load, and productivity of female brickfield workers in India. DESIGN: A questionnaire study (n=120), environmental temperature, and weekly work productivity analyses were evaluated for 8 months in the brickfields. Cardiac strain and walking speed (subset, n=40) were also studied and compared in hotter and colder days amongst the female brickfield workers. RESULTS: The subjects experience summer for about 5 months with additional heat stress radiating from the brick kiln. The weekly productivity data show a linear decline in productivity with increased maximum air temperature above 34.9°C. The cardiac parameters (peak heart rate (HRp), net cardiac cost (NCC), relative cardiac cost (RCC), and recovery heart rates) were significantly higher on hotter days (Wet Bulb Globe Temperature (WBGTout) index: 26.9°C to 30.74°C) than on cooler days (WBGTout index: 16.12°C to 19.37°C) for the brick molders; however, this is not the case for the brick carriers. As the brick carriers adapt to hotter days by decreasing their walking speed, their productivity decreases. CONCLUSION: We conclude that high heat exposure in brickfields during summer caused physiological strain in both categories of female brickfield workers. A coping strategy employed by the brick carriers was to reduce their walking speed and thus lose part of their earnings. The lost productivity for every degree rise in temperature is about 2% in the brickfields. This reduction will be exacerbated by climate change and may undermine the quality of life of female brickfield workers.

Cardiovascular load during summer work of two age groups of van-rickshaw pullers in West Bengal, India.

Van-rickshaw is a popular mode of transport of people and merchandise in developing countries. The purpose of this study was to assess the effect of age on cardiovascular load of van-rickshaw pullers in the summer season (March-June) in real situations. In 142 participants, divided into 2 age groups (25-40 and 41-55 years), cardiovascular load was assessed on the basis of working and partial recovery heart rate (HR), predicted maximal HR, working maximal HR, average working HR, percentage of reserved HR, sum of recovery heart beats, percentage of recovery, relative and net cardiac cost, etc. Except for percentage of recovery, all parameters differed significantly between the groups and were significantly correlated with age. As this activity is very stressful, it places a heavy demand on the cardiovascular system. Therefore, age is an important factor for sustainability of the work, especially in a hot environment. Some ergonomic interventions are necessary to reduce cardiovascular load.

A comparative ergonomics postural assessment of potters and sculptors in the unorganized sector in West Bengal, India.

Potters and sculptors perform their work in very awkward postures. The purpose of this study was to analyse these postures. The modified Nordic questionnaire was used to analyse musculoskeletal discomfort. Rapid entire body assessment (REBA) and rapid upper limb assessment (RULA) were used to evaluate the subjects' postures. There were no significant differences between times of discomfort and the group of subjects. However, there were significant differences in discomfort in different body parts. The analysis indicated that various body postures were harmful to the subjects and that there were profound deviations from natural curvature of various body parts due to awkward body postures. Ergonomics intervention was required to improve the quality of life.

Heat exposure, cardiovascular stress and work productivity in rice harvesters in India: implications for a climate change future.

Excessive workplace heat exposures create well-known risks of heat stroke, and it limits the workers' capacity to sustain physical activity. There is very limited evidence available on how these effects reduce work productivity, while the quantitative relationship between heat and work productivity is an essential basis for climate change impact assessments. We measured hourly heat exposure in rice fields in West Bengal and recorded perceived health problems via interviews of 124 rice harvesters. In a sub-group (n = 48) heart rate was recorded every minute in a standard work situation. Work productivity was recorded as hourly rice bundle collection output. The hourly heat levels (WBGT = Wet Bulb Globe Temperature) were 26-32°C (at air temperatures of 30-38°C), exceeding international standards. Most workers reported exhaustion and pain during work on hot days. Heart rate recovered quickly at low heat, but more slowly at high heat, indicating cardiovascular strain. The hourly number of rice bundles collected was significantly reduced at WBGT>26°C (approximately 5% per°C of increased WBGT). We conclude that high heat exposure in agriculture caused heat strain and reduced work productivity. This reduction will be exacerbated by climate change and may undermine the local economy.

Assessment of the lung function status of the goldsmiths working in an unorganized sector of India.

CONTEXT: Exposure to various types of fumes and gases are very common in Jewelery industries. No Report is available regarding the effects of those fumes and gases on the respiratory functions of the goldsmiths. Due to lack of proper monitoring of the workplace environments in these unorganized sectors, workers get very much affected by the occupational exposures to those irritants. AIMS: The present study aimed to investigate whether the occupational exposures to fumes and gases might alter the lung functions of the goldsmiths. MATERIALS AND METHODS: A total of 118 goldsmiths and 66 unexposed control subjects were taken randomly for the study. The goldsmiths were further classified in 3 groups according to duration (year) of exposures in the work environment, ETA1 (less than 5 years), ETA2 (more than 5 years but less than 10 years), and ETA3 (more than 10 years). Peak expiratory flow rates (PEFR), forced vital capacity (FVC), and forced expiratory flow rates of different intervals (FEF25%, FEF50%, FEF75%, FEF25-75%) were measured using computerized Spirometer (Maestros Mediline, India). The statistical analyses were carried out using Minitab software version 3. RESULTS: Lung functions of the goldsmiths significantly (P < 0.01) decreased from that of the control group. Inter-group comparison also showed the deteriorations of lung functions was associated with exposure time, and more exposed workers had significantly less (P < 0.01) efficiencies of lung functions. CONCLUSIONS: Workplace fumes and gases were responsible for deterioration of the lung function status of the goldsmiths.

Adverse respiratory effects associated with cadmium exposure in small-scale jewellery workshops in India.

BACKGROUND: Cadmium (Cd) is an important metal with both common occupational and environmental sources of exposure. Although it is likely to cause adverse respiratory effects, relevant human data are relatively sparse. METHODS: A cross-sectional study of 133 workers in jewellery workshops using Cd under poor hygienic conditions and 54 referent jewellery sales staffs was performed. We assessed symptoms, performed spirometry, measured urinary Cd levels in all study subjects and quantified airborne total oxidant contents for 35 job areas in which the studied workforce was employed. We tested the association of symptoms with exposure relative to the unexposed referents using logistic regression analysis, and tested the association between urinary Cd levels and lung function using multiple regression analysis, adjusting for demographics, smoking and area-level airborne oxidants. RESULTS: Exposed workers had 10 times higher urinary Cd values than referents (geometric mean 5.8 vs 0.41 µg/dl; p<0.01). Of the exposed subjects, 75% reported respiratory tract symptoms compared with 33% of the referents (OR=3.1, 95% CI 1.4 to 7.3). Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also lower among the exposed workers than the referents (>600 ml decrement for each, p<0.001). For every 1 µg increase in urinary Cd there was a 34 ml decrement in FVC and a 39 ml decrement in FEV1 (p<0.01), taking into account other covariates including workplace airborne oxidant concentrations. CONCLUSIONS: This cohort of heavily exposed jewellery workers experienced frequent respiratory symptoms and manifested a marked deficit in lung function, demonstrating a strong response to Cd exposure.